Comparison of pre-procedural ultrasound assisted modified paramedian technique versus ultrasound assisted midline technique on successful dural puncture on first attempt in patients undergoing surgeries under spinal anesthesia - A Randomized Controlled Trial.

This is a randomized controlled trial done at Pondicherry Institute of Medical Sciences which will compare pre-procedural ultrasound-assisted midline and modified paramedian techniques (0.5 cm & 1 cm lateral) for spinal anesthesia in 108 adult surgical patients. Primary outcome is first-attempt dural puncture success; secondary outcomes include number of passes, LFD visibility, anatomical distances, and complications. The study hypothesizes that modified paramedian approaches will yield higher first-attempt success rates, fewer needle manipulations, and reduced patient discomfort compared to the midline technique.